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Individual

MATTHIEU PHILIPPE DECLERCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
300 PASTEUR DR, ALWAY BUILDING, ROOM 121, STANFORD, CA 94305-2200
(650) 725-9445
Mailing address
203 ANNANDALE RD, PASADENA, CA 91105-1407
(323) 828-8482

Taxonomy

Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
A101627
CA
207P00000X
Emergency Medicine Physician
48842
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
021043
KAISER COMMERCIAL NUMBER
CO
05
68132735
CO
Enumeration date
11/09/2007
Last updated
09/03/2013
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